Associations Between Different Self-reported Social Risks and Neighborhood-level Resources in Medicaid Patients

Abstract

Background: Adverse social conditions are a key contributor to health disparities. Improved understanding of how social risk factors interact with each other and with neighborhood characteristics may inform efforts to reduce health disparities.

Data: A questionnaire of 29,281 patients was collected through the enrollment of Medicaid beneficiaries in a large Northern California integrated health care delivery system between May 2016 and February 2020.

Exposures: Living in the least resourced quartile of neighborhoods as measured by a census-tract level Neighborhood Deprivation Index score.

Main outcomes: Five self-reported social risk factors: financial need, food insecurity, housing barriers, transportation barriers, and functional limitations.

Results: Nearly half (42.0%) of patients reported at least 1 social risk factor; 22.4% reported 2 or more. Mean correlation coefficient between social risk factors was ρ=0.30. Multivariable logistic models controlling for age, race/ethnicity, sex, count of chronic conditions, and insurance source estimated that living in the least resourced neighborhoods was associated with greater odds of food insecurity (adjusted odds ratio=1.07, 95% confidence interval: 1.00-1.13) and transportation barriers (adjusted odds ratio=1.20, 95% confidence interval: 1.11-1.30), but not financial stress, housing barriers, or functional limitations.

Conclusions and relevance: We found that among 5 commonly associated social risk factors, Medicaid patients in a large Northern California health system typically reported only a single factor and that these factors did not correlate strongly with each other. We found only modestly greater social risk reported by patients in the least resourced neighborhoods. These results suggest that individual-level interventions should be targeted to specific needs whereas community-level interventions may be similarly important across diverse neighborhoods.

Figure 1:. Tetrachoric correlations of social risk factors.

This heatmap displays results of pairwise correlations between five self-reported social risk factors. Colors represent the strength of correlation between each pair of items, with darker shades of blue representing higher pairwise correlation coefficients.